[B]ARRE — Vermont has a good record when it comes to going after Medicaid fraud for a simple reason, according to Rep. Peter Welch, D-Vt.
“It drives Vermonters crazy,” the congressman told reporters at a news conference Monday. “They hate it.”
Now, Welch is spearheading an effort to crack down on Medicaid and Medicare fraud nationwide.
Welch is co-sponsoring a bill in Congress that would standardize the process for reporting and tracking fraudsters across state borders.
The legislation would require states to notify the Centers for Medicare and Medicaid Services (CMS) when a service provider is found to be fraudulently billing. CMS would then make that information available on a website, where other state agencies could check to see if a certain person has been decertified.
“This is intended to crack down effectively on a fraudulent actor who’s caught in one state from being able to continue to perpetuate the fraud in another,” Welch said at the offices of Capstone Community Action in Barre on Monday.
Welch’s proposal encourages states to check the CMS website. If a state pays out Medicaid claims to a provider who was delisted, the state would have to pay back the federal government for the portion of payment that was covered by federal dollars.
“There is a requirement that the states have to get their acts together, too,” Welch said.
Vermont Attorney General Bill Sorrell endorsed the bill, saying that it “just fundamentally makes sense.”
At 3.7 percent, Vermont has the second lowest uninsured rate in the country. But Vermont also has heavy reliance on Medicaid. Some 200,000 people are enrolled in the program across the state — a third of the population.
Medicaid fraud in Vermont tends to be at a smaller scale than in other states, Sorrell said. Unlike the million-dollar operations going on in other parts of the country, most Medicaid fraud within Vermont tends to be on a relatively small-scale level.
Still, the Attorney General’s Office goes after Medicaid fraud with regularity in Vermont. Last month, for instance, a Rutland doctor was ordered to pay $84,000 for Medicaid fraud, and two Springfield women were convicted of fraud in a case that involved home health care.
Because of the wide use of Medicaid among Vermonters, the state is vulnerable, Sorrell said.
“The importance of knowing the bad actors from other states is pronounced here, despite the fact that we haven’t been victimized in the same way as other states,” Sorrell said.
Secretary of Human Services Hal Cohen also welcomed the proposed legislation.
Vermont’s Medicaid system has an annual price tag of approximately $1.2 billion, according to Cohen, a portion of which is footed by the federal government. Cohen didn’t have an estimate for the cost to the state of fraud.
“In our state, fortunately, the numbers are low,” Cohen said. “It happens, but it’s not significant amounts.”
Welch’s legislation would have an additional benefit to Vermonters, Cohen said. By rooting out people who have been decertified, the state could improve the overall quality of services that Vermonters receive, he said.
The bill passed unanimously out of the Energy and Commerce Committee, Welch said, and he’s optimistic the legislation will gain the support of many House Republicans.
“We’re going to give our new speaker, Paul Ryan, a chance to pass a bill that’s going to save the taxpayer money,” Welch said.
Even though many GOP lawmakers don’t agree with Welch’s support of expanding Medicaid eligibility, the congressman said, “they’re with me on rooting out fraud.”
“My view is that those of us who are supporters of the expansion of health care have an enormous responsibility to make sure that it’s appropriate, people aren’t getting ripped off, the taxpayer’s not getting ripped off,” Welch said.
